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General Assembly Substitute Bill No. 10
January Session, 2023
AN ACT PROMOTING ACCESS TO AFFORDABLE PRESCRIPTION
DRUGS, HEALTH CARE COVERAGE, TRANSPARENCY IN HEALTH
CARE COSTS, HOME AND COMMUNITY-BASED SUPPORT FOR
VULNERABLE PERSONS AND RIGHTS REGARDING GENDER
IDENTITY AND EXPRESSION.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Subsection (d) of section 19a-754b of the general statutes is 1
repealed and the following is substituted in lieu thereof (Effective July 1, 2
2023): 3
(d) (1) On or before March 1, 2020, and annually thereafter, the 4
executive director of the Office of Health Strategy, in consultation with 5
the Comptroller, Commissioner of Social Services and Commissioner of 6
Public Health, shall prepare and make public a list of not more than ten 7
outpatient prescription drugs that the executive director, in the 8
executive director's discretion, determines are (A) provided at 9
substantial cost to the state, considering the net cost of such drugs, or 10
(B) critical to public health. The list shall include outpatient prescription 11
drugs from different therapeutic classes of outpatient prescription 12
drugs and at least one generic outpatient prescription drug. 13
(2) [The executive director shall not list any outpatient prescription 14
drug under subdivision (1) of this subsection unless the wholesale 15
acquisition cost of the drug, less all rebates paid to the state for such 16 Substitute Bill No. 10
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drug during the immediately preceding calendar year, (A) increased by 17
at least (i) twenty per cent during the immediately preceding calendar 18
year, or (ii) fifty per cent during the immediately preceding three 19
calendar years, and (B) was not less than sixty dollars for (i) a thirty-day 20
supply of such drug, or (ii) a course of treatment of such drug lasting 21
less than thirty days.] Prior to publishing the annual list of outpatient 22
prescription drugs pursuant to subdivision (1) of this subsection, the 23
executive director shall prepare a preliminary list of those outpatient 24
prescription drugs that the executive director plans to include on the 25
list. The executive director shall make the preliminary list available for 26
public comment for not less than thirty days, during which time any 27
manufacturer of an outpatient prescription drug named on the 28
preliminary list may produce documentation to establish that the 29
wholesale acquisition cost of the drug, less all rebates paid to the state 30
for such drug during the immediately preceding calendar year, does not 31
exceed the limits established in subdivision (3) of this subsection. If such 32
documentation establishes, to the satisfaction of the executive director, 33
that the wholesale acquisition cost, less all rebates paid to the state for 34
such drug during the immediately preceding calendar year, does not 35
exceed the limits established in subdivision (3) of this subsection, the 36
executive director shall remove such drug from the list before 37
publishing the final list. The executive director shall publish a final list 38
pursuant to subdivision (1) of this subsection not later than fifteen days 39
after the closing of the public comment period. 40
(3) The executive director shall not list any outpatient prescription 41
drug under subdivision (1) or (2) of this subsection unless the wholesale 42
acquisition cost of the drug, less all rebates paid to the state for such 43
drug during the immediately preceding calendar year, (A) increased by 44
at least sixteen per cent cumulatively during the immediately preceding 45
two calendar years, and (B) was not less than forty dollars for a course 46
of therapy. 47
[(3)] (4) (A) The pharmaceutical manufacturer of an outpatient 48
prescription drug included on a list prepared by the executive director 49 Substitute Bill No. 10
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pursuant to subdivision (1) of this subsection shall provide to the office, 50
in a form and manner specified by the executive director, (i) a written, 51
narrative description, suitable for public release, of all factors that 52
caused the increase in the wholesale acquisition cost of the listed 53
outpatient prescription drug, and (ii) aggregate, company-level research 54
and development costs and such other capital expenditures that the 55
executive director, in the executive director's discretion, deems relevant 56
for the most recent year for which final audited data are available. 57
(B) The quality and types of information and data that a 58
pharmaceutical manufacturer submits to the office under this 59
subdivision shall be consistent with the quality and types of information 60
and data that the pharmaceutical manufacturer includes in (i) such 61
pharmaceutical manufacturer's annual consolidated report on Securities 62
and Exchange Commission Form 10 -K, or (ii) any other public 63
disclosure. 64
[(4)] (5) The office shall establish a standardized form for reporting 65
information and data pursuant to this subsection after consulting with 66
pharmaceutical manufacturers. The form shall be designed to minimize 67
the administrative burden and cost of reporting on the office and 68
pharmaceutical manufacturers. 69
Sec. 2. (NEW) (Effective January 1, 2024, and applicable to contracts 70
entered into, amended or renewed on and after January 1, 2024) (a) For the 71
purposes of this section and sections 3 and 4 of this act: 72
(1) "Distributor" means any person or entity, including any 73
wholesaler, who supplies drugs, devices or cosmetics prepared, 74
produced or packaged by manufacturers, to other wholesalers, 75
manufacturers, distributors, hospitals, clinics, practitioners or 76
pharmacies or federal, state and municipal agencies; 77
(2) "Manufacturer" means the following: 78
(A) Any entity described in 42 USC 1396r-8(k)(5) that is subject to the 79
pricing limitations set forth in 42 USC 256b; and 80 Substitute Bill No. 10
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(B) Any wholesaler described in 42 USC 1396r-8(k)(11) engaged in the 81
distribution of covered drugs for any entity described in 42 USC1396r-82
8(k)(5) that is subject to the pricing limitations set forth in 42 USC 256b; 83
(3) "ERISA plan" means an employee welfare benefit plan subject to 84
the Employee Retirement Income Security Act of 1974, as amended from 85
time to time; 86
(4) (A) "Health benefit plan" means any insurance policy or contract 87
offered, delivered, issued for delivery, renewed, amended or continued 88
in the state by a health carrier to provide, deliver, pay for or reimburse 89
any of the costs of health care services; 90
(B) "Health benefit plan" does not include: 91
(i) Coverage of the type specified in subdivisions (5), (6), (7), (8), (9), 92
(14), (15) and (16) of section 38a-469 of the general statutes or any 93
combination thereof; 94
(ii) Coverage issued as a supplement to liability insurance; 95
(iii) Liability insurance, including general liability insurance and 96
automobile liability insurance; 97
(iv) Workers' compensation insurance; 98
(v) Automobile medical payment insurance; 99
(vi) Credit insurance; 100
(vii) Coverage for on-site medical clinics; or 101
(viii) Other similar insurance coverage specified in regulations issued 102
pursuant to the Health Insurance Portability and Accountability Act of 103
1996, P.L. 104-191, as amended from time to time, under which benefits 104
for health care services are secondary or incidental to other insurance 105
benefits; and 106 Substitute Bill No. 10
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(C) "Health benefit plan" does not include the following benefits if 107
such benefits are provided under a separate insurance policy, certificate 108
or contract or are otherwise not an integral part of the plan: 109
(i) Limited scope dental or vision benefits; 110
(ii) Benefits for long-term care, nursing home care, home health care, 111
community-based care or any combination thereof; 112
(iii) Other similar, limited benefits specified in regulations issued 113
pursuant to the Health Insurance Portability and Accountability Act of 114
1996, P.L. 104-191, as amended from time to time; 115
(iv) Other supplemental coverage, similar to coverage of the type 116
specified in subdivisions (9) and (14) of section 38a-469 of the general 117
statutes, provided under a group health plan; or 118
(v) Coverage of the type specified in subdivision (3) or (13) of section 119
38a-469 of the general statutes or other fixed indemnity insurance if (I) 120
such coverage is provided under a separate insurance policy, certificate 121
or contract, (II) there is no coordination between the provision of the 122
benefits and any exclusion of benefits under any group health plan 123
maintained by the same plan sponsor, and (III) the benefits are paid with 124
respect to an event without regard to whether benefits were also 125
provided under any group health plan maintained by the same plan 126
sponsor; 127
(5) "Maximum fair price" means the maximum rate for a prescription 128
drug published by the Secretary of the United States Department of 129
Health and Human Services under Section 1191 of the Inflation 130
Reduction Act of 2022, P.L. 117-169, as amended from time to time. 131
"Maximum fair price" does not include any dispensing fee paid to a 132
pharmacy for dispensing any referenced drug; 133
(6) "Participating ERISA plan" means any employee welfare benefit 134
plan subject to the Employee Retirement Income Security Act of 1974, as 135
amended from time to time, that elects to participate in the requirements 136 Substitute Bill No. 10
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pursuant to section 3 or 4 of this act; 137
(7) "Price applicability period" has the same meaning as provided in 138
Section 1191 of the Inflation Reduction Act of 2022, P.L. 117-169, as 139
amended from time to time; 140
(8) "Purchaser" means any state entity, health benefit plan or 141
participating ERISA plan; 142
(9) "Referenced drug" means any prescription drug subject to the 143
maximum fair price; and 144
(10) "State entity" means any agency of this state, including, any 145
agent, vendor, fiscal agent, contractor or other person acting on behalf 146
of this state, that purchases a prescription drug on behalf of this state for 147
a person who maintains a health insurance policy that is paid for by this 148
state, including health insurance coverage offered through local, state or 149
federal agencies or through organizations licensed in this state. "State 150
entity" does not include the medical assistance program administered 151
under Title XIX of the Social Security Act, 42 USC 1396 et seq., as 152
amended from time to time. 153
Sec. 3. (NEW) (Effective January 1, 2024, and applicable to contracts 154
entered into, amended or renewed on and after January 1, 2024) (a) No 155
purchaser shall purchase a referenced drug or seek reimbursement for 156
a referenced drug to be dispensed, delivered or administered to an 157
insured in this state, by hand delivery, mail or by other means, directly 158
or through a distributor, for a cost that exceeds the maximum fair price 159
during the price applicability period for such drug published pursuant 160
to Section 1191 of the Inflation Reduction Act of 2022, P.L. 117-169, as 161
amended from time to time. 162
(b) Each purchaser shall calculate such purchaser's savings generated 163
pursuant to subsection (a) of this section and shall apply such savings 164
to reduce prescription drug costs for the purchaser's insureds. Not later 165
than January fifteenth of each calendar year, a purchaser shall submit a 166
report to the Insurance Department that (1) provides an assessment of 167 Substitute Bill No. 10
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such purchaser's savings for each referenced drug for the previous 168
calendar year, and (2) identifies how each purchaser applied such 169
savings to (A) reduce prescription drug costs for such purchaser's 170
insureds, and (B) decrease cost disparities. 171
(c) An ERISA plan may elect to participate in the requirements of this 172
section by notifying the Insurance Department, in writing, not later than 173
January first of each calendar year. 174
(d) Any violation by a purchaser of subsection (a) of this section shall 175
be subject to a civil penalty of one thousand dollars for each such 176
violation. 177
(e) The Insurance Commissioner shall adopt regulations, in 178
accordance with the provisions of chapter 54 of the general statutes, to 179
implement the provisions of this section and section 4 of this act. 180
Sec. 4. (NEW) (Effective January 1, 2024, and applicable to contracts 181
entered into, amended or renewed on and after January 1, 2024) (a) No 182
manufacturer or distributor of a referenced drug shall withdraw such 183
referenced drug from sale or distribution in this state to attempt to avoid 184
any loss of revenue resulting from the maximum fair price requirement 185
established in section 3 of this act. 186
(b) Each manufacturer or distributor shall provide not less than one 187
hundred eighty days' written notice to the Insurance Commissioner and 188
Attorney General prior to withdrawing a referenced drug from sale or 189
distribution in this state. 190
(c) If any manufacturer or distributor violates the provisions of 191
subsection (a) or (b) of this section, such manufacturer or distributor 192
shall be subject to a civil penalty of (1) five hundred thousand dollars, 193
or (2) such purchaser's amount of annual savings generated pursuant to 194
subsection (a) of section 3 of this act, as determined by the Insurance 195
Commissioner, whichever is greater. 196
(d) It shall be a violation of this section for any manufacturer or 197 Substitute Bill No. 10
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distributor of a referenced drug to negotiate with a purchaser or seller 198
of a referenced drug at a price that exceeds the maximum fair price. 199
(e) The Attorney General shall have exclusive authority to enforce 200
violations of this section and section 3 of this act. 201
Sec. 5. (NEW) (Effective July 1, 2023) (a) As used in this section and 202
section 6 of this act, (1) "federal 340B drug pricing program" means the 203
plan described in Section 340B of the Public Health Service Act, 42 USC 204
256b, as amended from time to time, (2) "340B covered entity" means a 205
provider participating in the federal 340B drug pricing program, (3) 206
"prescription drug" has the same meaning as provided in section 19a-207
754b of the general statutes, and (4) "rebate" has the same meaning as 208
provided in section 38a-479ooo of the general statutes. 209
(b) Not later than January fifteenth annually, a 340B covered entity 210
shall provide a report to the executive director of the Office of Health 211
Strategy, established pursuant to section 19a-754a of the general 212
statutes, as amended by this act, providing, for the previous calendar 213
year (1) a list of all prescription drugs, identified by the national drug 214
code number, purchased through the federal 340B drug pricing 215
program, (2) the actual purchase price of each such prescription drug 216
after any rebate or discount provided pursuant to the program, (3) the 217
actual payment each such 340B covered entity received from any private 218
or public health insurance plan, except for Medicaid and Medicare, or 219
patient for each such prescription drug, (4) the average percentage 220
savings realized by each 340B covered entity on the cost of prescription 221
drugs under the 340B program, and (5) how the 340B covered entity 222
used prescription drug cost savings under the program. The executive 223
director shall include a link to the report on the office's Internet web site. 224
Sec. 6. (NEW) (Effective July 1, 2023) No 340B covered entity shall 225
attempt to collect as medical debt any payment for a prescription drug 226
obtained with a rebate or at a discounted price through the federal 340B 227
drug pricing program that exceeds the cost of such drug paid by such 228
entity. 229 Substitute Bill No. 10
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Sec. 7. (NEW) (Effective July 1, 2023) (a) There is established a 230
Prescription Drug Payment Evaluation Committee to recommend 231
upper payment limits on not fewer than eight prescription drugs to the 232
executive director of the Office of Health Strategy based on evaluation 233
of upper payment limits on such drugs set by other states or foreign 234
jurisdictions. 235
(b) Members of the committee shall be as follows: 236
(1) Three appointed by the speaker of the House of Representatives, 237
who shall be (A) a representative of a state-wide health care advocacy 238
coalition, (B) a representative of a state-wide advocacy organization for 239
elderly persons, and (C) a representative of a state-wide organization 240
for diverse communities; 241
(2) Three appointed by the president pro tempore of the Senate, who 242
shall be (A) a representative of a labor union, (B) a health services 243
researcher, and (C) a consumer who has experienced barriers to 244
obtaining prescription drugs due to the cost of such drugs; 245
(3) Two appointed by the majority leader of the House of 246
Representatives, who shall be representatives of 340B covered entities, 247
as defined in section 5 of this act; 248
(4) Two appointed by the minority leader of the House of 249
Representatives, who shall be representatives of private insurers; 250
(5) Two appointed by the majority leader of the Senate, who shall be 251
representatives of organizations representing health care providers; 252
(6) Two appointed by the minority leader of the Senate, who shall be 253
(A) a representative of a pharmaceutical company doing business in the 254
state, and (B) a representative of an academic institution with expertise 255
in health care costs; 256
(7) Two appointed by the Governor, who shall be (A) a representative 257
of pharmacists, and (B) a representative of pharmacy benefit managers; 258 Substitute Bill No. 10
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(8) The Secretary of the Office of Policy and Management, or the 259
secretary's designee; 260
(9) The Commissioner of Social Services, or the commissioner's 261
designee; 262
(10) The Commissioner of Public Health, or the commissioner's 263
designee; 264
(11) The Insurance Commissioner, or the commissioner's designee; 265
(12) The Commissioner of Consumer Protection, or the 266
commissioner's designee; 267
(13) The executive director of the Office of Health Strategy, or the 268
executive director's designee; and 269
(14) The Healthcare Advocate, or the Healthcare Advocate's 270
designee. 271
(c) All initial appointments to the committee shall be made not later 272
than August 1, 2023. Any vacancy shall be filled by the appointing 273
authority. 274
(d) The speaker of the House of Representatives and the president 275
pro tempore of the Senate shall select the chairpersons of the committee 276
from among the members of the committee. Such chairpersons shall 277
schedule the first meeting of the committee, which shall be held not later 278
than September 1, 2023. 279
(e) The administrative staff of the joint standing committee of the 280
General Assembly having cognizance of matters relating to insurance 281
shall serve as administrative staff of the committee. 282
(f) Not later than December 1, 2023, and annually thereafter, the 283
committee shall submit a report, in accordance with the provisions of 284
section 11-4a of the general statutes, to the executive director of the 285
Office of Health Strategy and the joint standing committees of the 286 Substitute Bill No. 10
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General Assembly having cognizance of matters relating to 287
appropriations and the budgets of state agencies, human services, 288
insurance and public health with its recommendations concerning 289
upper payment limits for not fewer than eight prescription drugs. 290
Sec. 8. Section 3-112 of the general statutes is repealed and the 291
following is substituted in lieu thereof (Effective July 1, 2023): 292
(a) The Comptroller shall: (1) Establish and maintain the accounts of 293
the state government and perform such other duties as are prescribed 294
by the Constitution of the state; (2) register all warrants or orders for the 295
disbursement of the public money; (3) adjust and settle all demands 296
against the state not first adjusted and settled by the General Assembly 297
and give orders on the Treasurer for the balance found and allowed; (4) 298
prescribe the mode of keeping and rendering all public accounts of 299
departments or agencies of the state and of institutions supported by the 300
state or receiving state aid by appropriation from the General Assembly; 301
(5) prepare and issue effective accounting and payroll manuals for use 302
by the various agencies of the state; (6) from time to time, examine and 303
state the amount of all debts and credits of the state; present all claims 304
in favor of the state against any bankrupt, insolvent debtor or deceased 305
person; and institute and maintain suits, in the name of the state, against 306
all persons who have received money or property belonging to the state 307
and have not accounted for it; and (7) administer the Connecticut 308
Retirement Security Program, established pursuant to section 31-418. 309
(b) All moneys recovered, procured or received for the state by the 310
authority of the Comptroller shall be paid to the Treasurer, who shall 311
file a duplicate receipt therefor with the Comptroller. The Comptroller 312
may require reports from any department, agency or institution as 313
aforesaid upon any matter of property or finance at any time and under 314
such regulations as the Comptroller prescribes and shall require special 315
reports upon request of the Governor, and the information contained in 316
such special reports shall be transmitted by him to the Governor. All 317
records, books and papers in any public office shall at all reasonable 318
times be open to inspection by the Comptroller. The Comptroller may 319 Substitute Bill No. 10
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draw his order on the Treasurer for a petty cash fund for any budgeted 320
agency. Expenditures from such petty cash funds shall be subject to such 321
procedures as the Comptroller establishes. In accordance with 322
established procedures, the Comptroller may enter into such contractual 323
agreements as may be necessary for the discharge of his duties. As used 324
in this section, "adjust" means to determine the amount equitably due in 325
respect to each item of each claim or demand. 326
(c) The Comptroller shall establish and administer a prescription 327
drug discount card program available to all residents of the state. The 328
Comptroller may coordinate participation in a multistate prescription 329
drug consortium for the purposes of pooling prescription drug 330
purchasing power to lower costs by negotiating discounts with 331
prescription drug manufacturers and coordinating volume discount 332
contracting. 333
Sec. 9. Section 38a-477g of the general statutes is repealed and the 334
following is substituted in lieu thereof (Effective January 1, 2024): 335
(a) As used in this section: [(1) "Covered person", "facility" and "health 336
carrier" have the same meanings as provided in section 38a-591a, (2) 337
"health care provider" has the same meaning as provided in subsection 338
(a) of section 38a-477aa, and (3) "intermediary", "network", "network 339
plan" and "participating provider" have the same meanings as provided 340
in subsection (a) of section 38a-472f.] 341
(1) "All-or-nothing clause" means a provision in a health care contract 342
that: 343
(A) Requires the health insurance carrier or health plan administrator 344
to include all members of a health care provider in a network plan; or 345
(B) Requires the health insurance carrier or health plan administrator 346
to enter into any additional contract with an affiliate of the health care 347
provider as a condition to entering into a contract with such health care 348
provider. 349 Substitute Bill No. 10
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(2) "Anti-steering clause" means a provision of a health care contract 350
that restricts the ability of the health insurance carrier or health plan 351
administrator from encouraging an enrollee to obtain a health care 352
service from a competitor of the hospital or health system, including 353
offering incentives to encourage enrollees to utilize specific health care 354
providers. 355
(3) "Anti-tiering clause" means a provision in a health care contract 356
that: 357
(A) Restricts the ability of the health insurance carrier or health plan 358
administrator to introduce and modify a tiered network plan or assign 359
health care providers into tiers; or 360
(B) Requires the health insurance carrier or health plan administrator 361
to place all members of a health care provider in the same tier of a tiered 362
network plan. 363
(4) "Covered person", "facility" and "health carrier" have the same 364
meanings as provided in section 38a-591a. 365
(5) "Health care provider" has the same meaning as provided in 366
subsection (a) of section 38a-477aa. 367
(6) "Health plan administrator" means a third-party administrator 368
who acts on behalf of a plan sponsor to administer a health benefit plan. 369
(7) "Intermediary", "network", "network plan" and "participating 370
provider" have the same meanings as provided in subsection (a) of 371
section 38a-472f. 372
(8) "Tiered network" has the same meaning as provided in section 373
38a-472f. 374
(9) "Value-based care" means a health care coverage model in which 375
providers, including hospitals and physicians, are paid based on patient 376
health outcomes. 377 Substitute Bill No. 10
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(b) (1) Each contract entered into, renewed or amended on or after 378
January 1, 2017, between a health carrier and a participating provider 379
shall include: 380
(A) A hold harmless provision that specifies protections for covered 381
persons. Such provision shall include the following statement or a 382
substantially similar statement: "Provider agrees that in no event, 383
including, but not limited to, nonpayment by the health carrier or 384
intermediary, the insolvency of the health carrier or intermediary, or a 385
breach of this agreement, shall the provider bill, charge, collect a deposit 386
from, seek compensation, remuneration or reimbursement from, or 387
have any recourse against a covered person or a person (other than the 388
health carrier or intermediary) acting on behalf of the covered person 389
for services provided pursuant to this agreement. This agreement does 390
not prohibit the provider from collecting coinsurance, deductibles or 391
copayments, as specifically provided in the evidence of coverage, or fees 392
for uncovered services delivered on a fee-for-service basis to covered 393
persons. Nor does this agreement prohibit a provider (except for a 394
health care provider who is employed full-time on the staff of a health 395
carrier and has agreed to provide services exclusively to that health 396
carrier's covered persons and no others) and a covered person from 397
agreeing to continue services solely at the expense of the covered 398
person, as long as the provider has clearly informed the covered person 399
that the health carrier does not cover or continue to cover a specific 400
service or services. Except as provided herein, this agreement does not 401
prohibit the provider from pursuing any available legal remedy."; 402
(B) A provision that in the event of a health carrier or intermediary 403
insolvency or other cessation of operations, the participating provider's 404
obligation to deliver covered health care services to covered persons 405
without requesting payment from a covered person other than a 406
coinsurance, copayment, deductible or other out-of-pocket expense for 407
such services will continue until the earlier of (i) the termination of the 408
covered person's coverage under the network plan, including any 409
extension of coverage provided under the contract terms or applicable 410 Substitute Bill No. 10
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state or federal law for covered persons who are in an active course of 411
treatment, as set forth in subdivision (2) of subsection (g) of section 38a-412
472f, or are totally disabled, or (ii) the date the contract between the 413
health carrier and the participating provider would have terminated if 414
the health carrier or intermediary had remained in operation, including 415
any extension of coverage required under applicable state or federal law 416
for covered persons who are in an active course of treatment or are 417
totally disabled; 418
(C) (i) A provision that requires the participating provider to make 419
health records available to appropriate state and federal authorities 420
involved in assessing the quality of care provided to, or investigating 421
grievances or complaints of, covered persons, and (ii) a statement that 422
such participating provider shall comply with applicable state and 423
federal laws related to the confidentiality of medical and health records 424
and a covered person's right to view, obtain copies of or amend such 425
covered person's medical and health records; and 426
(D) (i) If such contract is entered into, renewed or amended before 427
July 1, 2022, definitions of what is considered timely notice and a 428
material change for the purposes of subparagraph (A) of subdivision (2) 429
of subsection (c) of this section, or (ii) if such contract is entered into, 430
renewed or amended on or after July 1, 2022, (I) a statement disclosing 431
the ninety-day advance written notice requirement established under 432
subparagraph (B) of subdivision (2) of subsection (c) of this section and 433
what is considered a material change for the purposes of subdivision (2) 434
of subsection (c) of this section, and (II) provisions affording the 435
participating provider a right to appeal any proposed change to the 436
provisions, other documents, provider manuals or policies disclosed 437
pursuant to subdivision (1) of subsection (c) of this section. 438
(2) The contract terms set forth in subparagraphs (A) and (B) of 439
subdivision (1) of this subsection shall (A) be construed in favor of the 440
covered person, (B) survive the termination of the contract regardless of 441
the reason for the termination, including the insolvency of the health 442
carrier, and (C) supersede any oral or written agreement between a 443 Substitute Bill No. 10
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health care provider and a covered person or a covered person's 444
authorized representative that is contrary to or inconsistent with the 445
requirements set forth in subdivision (1) of this subsection. 446
(3) No contract subject to this subsection shall include any provision 447
that conflicts with the provisions contained in the network plan or 448
required under this section, section 38a-472f or section 38a-477h. 449
(4) No health carrier or participating provider that is a party to a 450
contract under this subsection shall assign or delegate any right or 451
responsibility required under such contract without the prior written 452
consent of the other party. 453
(c) (1) At the time a contract subject to subsection (b) of this section is 454
signed, the health carrier or such health carrier's intermediary shall 455
disclose to a participating provider: 456
(A) All provisions and other documents incorporated by reference in 457
such contract; and 458
(B) If such contract is entered into, renewed or amended on or after 459
July 1, 2022, all provider manuals and policies incorporated by reference 460
in such contract, if any. 461
(2) While such contract is in force, the health carrier shall: 462
(A) If such contract is entered into, renewed or amended before July 463
1, 2022, timely notify a participating provider of any change to the 464
provisions or other documents specified under subparagraph (A) of 465
subdivision (1) of this subsection that will result in a material change to 466
such contract; or 467
(B) If such contract is entered into, renewed or amended on or after 468
July 1, 2022, provide to a participating provider at least ninety days' 469
advance written notice of any change to the provisions or other 470
documents specified under subparagraph (A) of subdivision (1) of this 471
subsection, and any change to the provider manuals and policies 472 Substitute Bill No. 10
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specified under subparagraph (B) of subdivision (1) of this subsection, 473
that will result in a material change to such contract or the procedures 474
that a participating provider must follow pursuant to such contract. 475
(d) (1) (A) Each contract between a health carrier and an intermediary 476
entered into, renewed or amended on or after January 1, 2017, shall 477
satisfy the requirements of this subsection. 478
(B) Each intermediary and participating providers with whom such 479
intermediary contracts shall comply with the applicable requirements 480
of this subsection. 481
(2) No health carrier shall assign or delegate to an intermediary such 482
health carrier's responsibilities to monitor the offering of covered 483
benefits to covered persons. To the extent a health carrier assigns or 484
delegates to an intermediary other responsibilities, such health carrier 485
shall retain full responsibility for such intermediary's compliance with 486
the requirements of this section. 487
(3) A health carrier shall have the right to approve or disapprove the 488
participation status of a health care provider or facility in such health 489
carrier's own or a contracted network that is subcontracted for the 490
purpose of providing covered benefits to the health carrier's covered 491
persons. 492
(4) A health carrier shall maintain at its principal place of business in 493
this state copies of all intermediary subcontracts or ensure that such 494
health carrier has access to all such subcontracts. Such health carrier 495
shall have the right, upon twenty days' prior written notice, to make 496
copies of any intermediary subcontracts to facilitate regulatory review. 497
(5) (A) Each intermediary shall, if applicable, (i) transmit to the health 498
carrier documentation of health care services utilization and claims 499
paid, and (ii) maintain at its principal place of business in this state, for 500
a period of time prescribed by the commissioner, the books, records, 501
financial information and documentation of health care services 502
received by covered persons, in a manner that facilitates regulatory 503 Substitute Bill No. 10
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review, and shall allow the commissioner access to such books, records, 504
financial information and documentation as necessary for the 505
commissioner to determine compliance with this section and section 506
38a-472f. 507
(B) Each health carrier shall monitor the timeliness and 508
appropriateness of payments made by its intermediary to participating 509
providers and of health care services received by covered persons. 510
(6) In the event of the intermediary's insolvency, a health carrier shall 511
have the right to require the assignment to the health carrier of the 512
provisions of a participating provider's contract that address such 513
participating provider's obligation to provide covered benefits. If a 514
health carrier requires such assignment, such health carrier shall remain 515
obligated to pay the participating provider for providing covered 516
benefits under the same terms and conditions as the intermediary prior 517
to the insolvency. 518
(e) The commissioner shall not act to arbitrate, mediate or settle (1) 519
disputes regarding a health carrier's decision not to include a health care 520
provider or facility in such health carrier's network or network plan, or 521
(2) any other dispute between a health carrier, such health carrier's 522
intermediary or one or more participating providers, that arises under 523
or by reason of a participating provider contract or the termination of 524
such contract. 525
(f) On and after January 1, 2024, no health insurance carrier, health 526
care provider, health plan administrator or any agent or other entity that 527
contracts on behalf of a health care provider, health insurance carrier or 528
health plan administrator may offer, solicit, request, amend, renew or 529
enter into a health care contract that would directly or indirectly include 530
any of the following provisions: 531
(1) An all-or-nothing clause; 532
(2) An anti-steering clause; 533 Substitute Bill No. 10
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(3) An anti-tiering clause; or 534
(4) Any other clause that results or intends to result in 535
anticompetitive effects. 536
(g) On and after January 1, 2024, any contract, written policy, written 537
procedure or agreement that contains a clause contrary to the provisions 538
set forth in subsection (f) of this section shall be null and void. All 539
remaining clauses of the contract shall remain in effect for the duration 540
of the contract term. 541
(h) Nothing in this section shall be construed to prohibit value-based 542
care. 543
(i) The Insurance Commissioner may adopt regulat ions, in 544
accordance with chapter 54, to implement the provisions of subsection 545
(f) of this section. 546
Sec. 10. Subsection (a) of section 17b-242 of the general statutes is 547
repealed and the following is substituted in lieu thereof (Effective July 1, 548
2023): 549
(a) The Department of Social Services shall determine the rates to be 550
paid to home health care agencies and home health aide agencies by the 551
state or any town in the state for persons aided or cared for by the state 552
or any such town. The Commissioner of Social Services shall establish a 553
fee schedule for home health services to be effective on and after July 1, 554
1994. The commissioner may annually modify such fee schedule if such 555
modification is needed to ensure that the conversion to an 556
administrative services organization is cost neutral to home health care 557
agencies and home health aide agencies in the aggregate and ensures 558
patient access. Utilization may be a factor in determining cost neutrality. 559
The commissioner shall increase the fee schedule for home health 560
services provided under the Connecticut home-care program for the 561
elderly established under section 17b-342, effective July 1, 2000, by two 562
per cent over the fee schedule for home health services for the previous 563
year. The commissioner shall include in the fee schedule not less than 564 Substitute Bill No. 10
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two licensed clinical social worker visits to each individual enrolled in 565
the Connecticut home-care program for the elderly or any home and 566
community-based Medicaid waiver program administered by the 567
Department of Social Services. The commissioner may increase any fee 568
payable to a home health care agency or home health aide agency upon 569
the application of such an agency evidencing extraordinary costs related 570
to (1) serving persons with AIDS; (2) high-risk maternal and child health 571
care; (3) escort services; or (4) extended hour services. In no case shall 572
any rate or fee exceed the charge to the general public for similar 573
services. A home health care agency or home health aide agency which, 574
due to any material change in circumstances, is aggrieved by a rate 575
determined pursuant to this subsection may, within ten days of receipt 576
of written notice of such rate from the Commissioner of Social Services, 577
request in writing a hearing on all items of aggrievement. The 578
commissioner shall, upon the receipt of all documentation necessary to 579
evaluate the request, determine whether there has been such a change 580
in circumstances and shall conduct a hearing if appropriate. The 581
Commissioner of Social Services shall adopt regulations, in accordance 582
with chapter 54, to implement the provisions of this subsection. The 583
commissioner may implement policies and procedures to carry out the 584
provisions of this subsection while in the process of adopting 585
regulations, provided notice of intent to adopt the regulations is 586
published in the Connecticut Law Journal not later than twenty days 587
after the date of implementing the policies and procedures. Such 588
policies and procedures shall be valid for not longer than nine months. 589
Sec. 11. (NEW) (Effective from passage) (a) For purposes of this section, 590
"certified community health worker" has the same meaning as provided 591
in section 20-195ttt of the general statutes. The Commissioner of Social 592
Services shall design and implement a program to provide Medicaid 593
reimbursement to certified community health workers for services 594
provided to HUSKY Health program members, including, but not 595
limited to: (1) Coordination of medical, oral and behavioral health care 596
services and social supports; (2) connection to and navigation of health 597
systems and services; (3) prenatal, birth, lactation and postpartum 598 Substitute Bill No. 10
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supports; and (4) health promotion, coaching and self-management 599
education. 600
(b) The commissioner shall provide reimbursement for the services 601
of certified community health workers in a manner and at a rate 602
conducive to workforce growth. 603
(c) The commissioner and the commissioner's designees shall consult 604
with certified community health workers and others throughout the 605
design and implementation of the certified community health worker 606
reimbursement program in a manner that (1) is inclusive of community-607
based and clinic-based certified community health workers; (2) is 608
representative of medical assistance program member demographics; 609
and (3) helps shape the reimbursement program's design and 610
implementation. 611
(d) The Department of Social Services shall coordinate with the Office 612
of Health Strategy to identify opportunities for the integration of 613
certified community health workers into the medical assistance 614
program. Not later than January 1, 2024, and annually thereafter until 615
the reimbursement program is fully implemented, the Department of 616
Social Services shall submit a report, in accordance with the provisions 617
of section 11-4a of the general statutes, to the joint standing committee 618
of the General Assembly having cognizance of matters relating to 619
human services and the Council on Medical Assistance Program 620
Oversight. Such report shall contain an update on the certified 621
community health worker reimbursement program and an evaluation 622
of its impact on health outcomes and health equity. 623
Sec. 12. Subsection (b) of section 19a-754a of the general statutes is 624
repealed and the following is substituted in lieu thereof (Effective from 625
passage): 626
(b) The Office of Health Strategy shall be responsible for the 627
following: 628
(1) Developing and implementing a comprehensive and cohesive 629 Substitute Bill No. 10
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health care vision for the state, including, but not limited to, a 630
coordinated state health care cost containment strategy; 631
(2) Promoting effective health planning and the provision of quality 632
health care in the state in a manner that ensures access for all state 633
residents to cost-effective health care services, avoids the duplication of 634
such services and improves the availability and financial stability of 635
such services throughout the state; 636
(3) Directing and overseeing the State Innovation Model Initiative 637
and related successor initiatives; 638
(4) (A) Coordinating the state's health information technology 639
initiatives, (B) seeking funding for and overseeing the planning, 640
implementation and development of policies and procedures for the 641
administration of the all-payer claims database program established 642
under section 19a-775a, (C) establishing and maintaining a consumer 643
health information Internet web site under section 19a-755b, and (D) 644
designating an unclassified individual from the office to perform the 645
duties of a health information technology officer as set forth in sections 646
17b-59f and 17b-59g; 647
(5) Directing and overseeing the Health Systems Planning Unit 648
established under section 19a-612 and all of its duties and 649
responsibilities as set forth in chapter 368z; 650
(6) Convening forums and meetings with state government and 651
external stakeholders, including, but not limited to, the Connecticut 652
Health Insurance Exchange, to discuss health care issues designed to 653
develop effective health care cost and quality strategies; 654
(7) Consulting with the Commissioner of Social Services, Insurance 655
Commissioner and Connecticut Health Insurance Exchange on the 656
Covered Connecticut program described in section 19a-754c; [and] 657
(8) (A) Setting an annual health care cost growth benchmark and 658
primary care spending target pursuant to section 19a-754g, (B) 659 Substitute Bill No. 10
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developing and adopting health care quality benchmarks pursuant to 660
section 19a-754g, (C) developing strategies, in consultation with 661
stakeholders, to meet such benchmarks and targets developed pursuant 662
to section 19a-754g, (D) enhancing the transparency of provider entities, 663
as defined in subdivision (13) of section 19a-754f, (E) monitoring the 664
development of accountable care organizations and patient-centered 665
medical homes in the state, and (F) monitoring the adoption of 666
alternative payment methodologies in the state; and 667
(9) Convening forums and meetings with Access Health Connecticut, 668
the Department of Public Health, the birth-to-three program, as defined 669
in section 17a-248, state home visiting programs, community action 670
agencies, hospitals, community health centers and other state 671
government and external stakeholders to align community health 672
worker programs funded by the state medical assistance program, block 673
grants, health care providers, private insurance carriers and other 674
external stakeholders. 675
Sec. 13. Section 17b-312 of the general statutes is repealed and the 676
following is substituted in lieu thereof (Effective from passage): 677
(a) The Commissioner of Social Services shall seek, in accordance 678
with the provisions of section 17b-8 and in consultation with the 679
Insurance Commissioner and the Office of Health Strategy established 680
under section 19a-754a, as amended by this act, a waiver under Section 681
1115 of the Social Security Act, as amended from time to time, to [seek] 682
obtain federal funds to support the Covered Connecticut program 683
established under section 19a-754c. Upon approval by the Centers for 684
Medicare and Medicaid Services, the Commissioner of Social Services 685
shall implement the waiver. 686
(b) Not later than thirty days after the effective date of this section, 687
the commissioner shall amend the waiver submitted in accordance with 688
subsection (a) of this section, to the extent permissible under federal law 689
and in accordance with section 17b-8, to provide coverage through the 690
Covered Connecticut program to persons otherwise qualified for the 691 Substitute Bill No. 10
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program whose income does not exceed two hundred per cent of the 692
federal poverty level. The commissioner shall consult with the 693
Insurance Commissioner and the executive director of the Office of 694
Health Strategy in submitting the waiver amendment. 695
Sec. 14. (NEW) (Effective from passage) (a) Not later than sixty days 696
after the effective date of this section, the Commissioner of Social 697
Services, in consultation with the Insurance Commissioner and the 698
executive director of the Office of Health Strategy established under 699
section 19a-754a of the general statutes, as amended by this act, shall 700
develop a plan for a second tier of the Covered Connecticut program 701
established pursuant to section 19a-754c of the general statutes. The plan 702
shall provide state-assisted health care coverage for persons otherwise 703
qualified for the program whose income exceeds two hundred per cent 704
of the federal poverty level but does not exceed three hundred per cent 705
of the federal poverty level. 706
(b) The plan developed pursuant to subsection (a) of this section may 707
include (1) reduced benefits from the Covered Connecticut program, 708
provided such benefits are in accordance with the requirements of the 709
Patient Protection and Affordable Care Act, P.L. 111-148, as amended 710
by the Health Care and Education Reconciliation Act, P.L. 111-152, as 711
both may be amended from time to time, and regulations adopted 712
thereunder, and (2) income-based copayments by enrollees. 713
(c) The Commissioner of Social Services shall submit the plan 714
developed in accordance with this section to the joint standing 715
committees of the General Assembly having cognizance of matters 716
relating to appropriations and the budgets of state agencies, human 717
services and insurance. Not later than thirty days after the date of their 718
receipt of such plan, the joint standing committees shall hold a public 719
hearing on the plan. At the conclusion of a public hearing held in 720
accordance with the provisions of this section, the joint standing 721
committees shall advise the commissioner of their approval, denial or 722
modifications, if any, of the commissioner's plan. If the joint standing 723
committees advise the commissioner of their denial of approval, the 724 Substitute Bill No. 10
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commissioner shall not implement the plan. If such committees do not 725
concur, the committee chairpersons shall appoint a committee of 726
conference which shall be composed of three members from each joint 727
standing committee. At least one member appointed from each joint 728
standing committee shall be a member of the minority party. The report 729
of the committee of conference shall be made to each joint standing 730
committee, which shall vote to accept or reject the report. The report of 731
the committee of conference may not be amended. If a joint standing 732
committee rejects the report of the committee of conference, that joint 733
standing committee shall notify the commissioner of the rejection and 734
the commissioner's plan shall be deemed approved. If the joint standing 735
committees accept the report, the committee having cognizance of 736
matters relating to appropriations and the budgets of state agencies 737
shall advise the commissioner of their approval, denial or modifications, 738
if any, of the commissioner's plan. If the joint standing committees do 739
not so advise the commissioner during the thirty-day period, the plan 740
shall be deemed denied. Any implementation of the plan developed 741
pursuant to this section shall be in accordance with the approval or 742
modifications, if any, of the joint standing committees of the General 743
Assembly having cognizance of matters relating to appropriations and 744
the budgets of state agencies, human services and insurance. 745
(d) To the extent permissible under federal law, the commissioner 746
may seek approval of a Medicaid waiver in accordance with section 17b-747
8 of the general statutes to obtain federal financial participation for the 748
plan developed pursuant to this section. 749
Sec. 15. Section 38a-1084 of the general statutes is repealed and the 750
following is substituted in lieu thereof (Effective from passage): 751
The exchange shall: 752
(1) Administer the exchange for both qualified individuals and 753
qualified employers; 754
(2) Commission surveys of individuals, small employers and health 755 Substitute Bill No. 10
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care providers on issues related to health care and health care coverage; 756
(3) Implement procedures for the certification, recertification and 757
decertification, consistent with guidelines developed by the Secretary 758
under Section 1311(c) of the Affordable Care Act, and section 38a-1086, 759
of health benefit plans as qualified health plans; 760
(4) Provide for the operation of a toll-free telephone hotline to 761
respond to requests for assistance; 762
(5) Provide for enrollment periods, as provided under Section 763
1311(c)(6) of the Affordable Care Act; 764
(6) Maintain an Internet web site through which enrollees and 765
prospective enrollees of qualified health plans may obtain standardized 766
comparative information on such plans including, but not limited to, the 767
enrollee satisfaction survey information under Section 1311(c)(4) of the 768
Affordable Care Act and any other information or tools to assist 769
enrollees and prospective enrollees evaluate qualified health plans 770
offered through the exchange; 771
(7) Publish the average costs of licensing, regulatory fees and any 772
other payments required by the exchange and the administrative costs 773
of the exchange, including information on moneys lost to waste, fraud 774
and abuse, on an Internet web site to educate individuals on such costs; 775
(8) On or before the open enrollment period for plan year 2017, assign 776
a rating to each qualified health plan offered through the exchange in 777
accordance with the criteria developed by the Secretary under Section 778
1311(c)(3) of the Affordable Care Act, and determine each qualified 779
health plan's level of coverage in accordance with regulations issued by 780
the Secretary under Section 1302(d)(2)(A) of the Affordable Care Act; 781
(9) Use a standardized format for presenting health benefit options in 782
the exchange, including the use of the uniform outline of coverage 783
established under Section 2715 of the Public Health Service Act, 42 USC 784
300gg-15, as amended from time to time; 785 Substitute Bill No. 10
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(10) Inform individuals, in accordance with Section 1413 of the 786
Affordable Care Act, of eligibility requirements for the Medicaid 787
program under Title XIX of the Social Security Act, as amended from 788
time to time, the Children's Health Insurance Program (CHIP) under 789
Title XXI of the Social Security Act, as amended from time to time, or 790
any applicable state or local public program, and enroll an individual in 791
such program if the exchange determines, through screening of the 792
application by the exchange, that such individual is eligible for any such 793
program; 794
(11) Collaborate with the Department of Social Services, to the extent 795
possible, to allow an enrollee who loses premium tax credit eligibility 796
under Section 36B of the Internal Revenue Code and is eligible for 797
HUSKY A or any other state or local public program, to remain enrolled 798
in a qualified health plan; 799
(12) Establish and make available by electronic means a calculator to 800
determine the actual cost of coverage after application of any premium 801
tax credit under Section 36B of the Internal Revenue Code and any cost-802
sharing reduction under Section 1402 of the Affordable Care Act; 803
(13) Establish a program for small employers through which 804
qualified employers may access coverage for their employees and that 805
shall enable any qualified employer to specify a level of coverage so that 806
any of its employees may enroll in any qualified health plan offered 807
through the exchange at the specified level of coverage; 808
(14) Offer enrollees and small employers the option of having the 809
exchange collect and administer premiums, including through 810
allocation of premiums among the various insurers and qualified health 811
plans chosen by individual employers; 812
(15) Grant a certification, subject to Section 1411 of the Affordable 813
Care Act, attesting that, for purposes of the individual responsibility 814
penalty under Section 5000A of the Internal Revenue Code, an 815
individual is exempt from the individual responsibility requirement or 816 Substitute Bill No. 10
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from the penalty imposed by said Section 5000A because: 817
(A) There is no affordable qualified health plan available through the 818
exchange, or the individual's employer, covering the individual; or 819
(B) The individual meets the requirements for any other such 820
exemption from the individual responsibility requirement or penalty; 821
(16) Provide to the Secretary of the Treasury of the United States the 822
following: 823
(A) A list of the individuals granted a certification under subdivision 824
(15) of this section, including the name and taxpayer identification 825
number of each individual; 826
(B) The name and taxpayer identification number of each individual 827
who was an employee of an employer but who was determined to be 828
eligible for the premium tax credit under Section 36B of the Internal 829
Revenue Code because: 830
(i) The employer did not provide minimum essential health benefits 831
coverage; or 832
(ii) The employer provided the minimum essential coverage but it 833
was determined under Section 36B(c)(2)(C) of the Internal Revenue 834
Code to be unaffordable to the employee or not provide the required 835
minimum actuarial value; and 836
(C) The name and taxpayer identification number of: 837
(i) Each individual who notifies the exchange under Section 838
1411(b)(4) of the Affordable Care Act that such individual has changed 839
employers; and 840
(ii) Each individual who ceases coverage under a qualified health 841
plan during a plan year and the effective date of that cessation; 842
(17) Provide to each employer the name of each employee, as 843 Substitute Bill No. 10
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described in subparagraph (B) of subdivision (16) of this section, of the 844
employer who ceases coverage under a qualified health plan during a 845
plan year and the effective date of the cessation; 846
(18) Perform duties required of, or delegated to, the exchange by the 847
Secretary or the Secretary of the Treasury of the United States related to 848
determining eligibility for premium tax credits, reduced cost-sharing or 849
individual responsibility requirement exemptions; 850
(19) Select entities qualified to serve as Navigators in accordance with 851
Section 1311(i) of the Affordable Care Act and award grants to enable 852
Navigators to: 853
(A) Conduct public education activities to raise awareness of the 854
availability of qualified health plans; 855
(B) Distribute fair and impartial information concerning enrollment 856
in qualified health plans and the availability of premium tax credits 857
under Section 36B of the Internal Revenue Code and cost-sharing 858
reductions under Section 1402 of the Affordable Care Act; 859
(C) Facilitate enrollment in qualified health plans; 860
(D) Provide referrals to the Office of the Healthcare Advocate or 861
health insurance ombudsman established under Section 2793 of the 862
Public Health Service Act, 42 USC 300gg-93, as amended from time to 863
time, or any other appropriate state agency or agencies, for any enrollee 864
with a grievance, complaint or question regarding the enrollee's health 865
benefit plan, coverage or a determination under that plan or coverage; 866
and 867
(E) Provide information in a manner that is culturally and 868
linguistically appropriate to the needs of the population being served by 869
the exchange; 870
(20) Review the rate of premium growth within and outside the 871
exchange and consider such information in developing 872 Substitute Bill No. 10
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recommendations on whether to continue limiting qualified employer 873
status to small employers; 874
(21) Credit the amount, in accordance with Section 10108 of the 875
Affordable Care Act, of any free choice voucher to the monthly 876
premium of the plan in which a qualified employee is enrolled and 877
collect the amount credited from the offering employer; 878
(22) Consult with stakeholders relevant to carrying out the activities 879
required under sections 38a-1080 to 38a-1090, inclusive, including, but 880
not limited to: 881
(A) Individuals who are knowledgeable about the health care system, 882
have background or experience in making informed decisions regarding 883
health, medical and scientific matters and are enrollees in qualified 884
health plans; 885
(B) Individuals and entities with experience in facilitating enrollment 886
in qualified health plans; 887
(C) Representatives of small employers and self-employed 888
individuals; 889
(D) The Department of Social Services; and 890
(E) Advocates for enrolling hard-to-reach populations; 891
(23) Meet the following financial integrity requirements: 892
(A) Keep an accurate accounting of all activities, receipts and 893
expenditures and annually submit to the Secretary, the Governor, the 894
Insurance Commissioner and the General Assembly a report concerning 895
such accountings; 896
(B) Fully cooperate with any investigation conducted by the Secretary 897
pursuant to the Secretary's authority under the Affordable Care Act and 898
allow the Secretary, in coordination with the Inspector General of the 899
United States Department of Health and Human Services, to: 900 Substitute Bill No. 10
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(i) Investigate the affairs of the exchange; 901
(ii) Examine the properties and records of the exchange; and 902
(iii) Require periodic reports in relation to the activities undertaken 903
by the exchange; and 904
(C) Not use any funds in carrying out its activities under sections 38a-905
1080 to 38a-1089, inclusive, that are intended for the administrative and 906
operational expenses of the exchange, for staff retreats, promotional 907
giveaways, excessive executive compensation or promotion of federal 908
or state legislative and regulatory modifications; 909
(24) (A) Seek to include the most comprehensive health benefit plans 910
that offer high quality benefits at the most affordable price in the 911
exchange, (B) encourage health carriers to offer tiered health care 912
provider network plans that have different cost-sharing rates for 913
different health care provider tiers and reward enrollees for choosing 914
low-cost, high-quality health care providers by offering lower 915
copayments, deductibles or other out-of-pocket expenses, and (C) offer 916
any such tiered health care provider network plans through the 917
exchange; 918
(25) Report at least annually to the General Assembly on the effect of 919
adverse selection on the operations of the exchange and make legislative 920
recommendations, if necessary, to reduce the negative impact from any 921
such adverse selection on the sustainability of the exchange, including 922
recommendations to ensure that regulation of insurers and health 923
benefit plans are similar for qualified health plans offered through the 924
exchange and health benefit plans offered outside the exchange. The 925
exchange shall evaluate whether adverse selection is occurring with 926
respect to health benefit plans that are grandfathered under the 927
Affordable Care Act, self-insured plans, plans sold through the 928
exchange and plans sold outside the exchange; [and] 929
(26) Consult with the Commissioner of Social Services, Insurance 930
Commissioner and Office of Health Strategy, established under section 931 Substitute Bill No. 10
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19a-754a, as amended by this act, for the purposes set forth in section 932
19a-754c; and 933
(27) (A) Notwithstanding the provisions of section 12-15, the 934
exchange shall make a written request to the Commissioner of Revenue 935
Services, for return or return information, as such terms are defined in 936
section 12-15, for use in conducting targeted outreach to uninsured 937
residents of this state. If the Commissioner of Revenue Services deems 938
such return or return information to be relevant to the targeted outreach 939
to uninsured residents, said commissioner may disclose such 940
information to the exchange. To effectuate the disclosure of such 941
information, the Commissioner of Revenue Services and the exchange 942
shall enter into a memorandum of understanding that sets forth the 943
specific information to be disclosed and contains the terms and 944
conditions under which said commissioner will disclose such 945
information to the exchange. Any return or return information disclosed 946
by the Commissioner of Revenue Services shall not be redisclosed by 947
the recipient to a third party without permission from the commissioner 948
and shall only be used by the exchange in the manner prescribed in the 949
memorandum of understanding. Any person who violates the 950
provisions of this subparagraph shall be fined not more than five 951
thousand dollars. 952
(B) To assist the exchange in conducting targeted outreach to 953
uninsured residents of this state, the Commissioner of Revenue Services 954
shall revise the tax return form prescribed under chapter 229 to include 955
space on the tax return for residents to authorize the exchange to contact 956
such residents regarding enrollment through the exchange. The 957
Commissioner of Revenue Services and the exchange shall develop 958
language to be included on the tax return form and shall include in the 959
instructions accompanying the tax return a description of how the 960
authorization provided will be relayed to the exchange. 961
Sec. 16. Section 19a-42 of the general statutes is repealed and the 962
following is substituted in lieu thereof (Effective July 1, 2023): 963 Substitute Bill No. 10
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(a) To protect the integrity and accuracy of vital records, a certificate 964
registered under chapter 93 may be amended only in accordance with 965
sections 19a-41 to 19a-45, inclusive, chapter 93, regulations adopted by 966
the Commissioner of Public Health pursuant to chapter 54 and uniform 967
procedures prescribed by the commissioner. Only the commissioner 968
may amend birth certificates to reflect changes concerning parentage or 969
the legal name of a parent or birth or marriage certificates to reflect 970
changes concerning gender. [change.] Amendments related to 971
parentage, [or] gender change or the legally changed name of a parent 972
shall result in the creation of a replacement certificate that supersedes 973
the original, and shall in no way reveal the original language changed 974
by the amendment. Any amendment to a vital record made by the 975
registrar of vital statistics of the town in which the vital event occurred 976
or by the commissioner shall be in accordance with such regulations and 977
uniform procedures. 978
(b) The commissioner and the registrar of vital statistics shall 979
maintain sufficient documentation, as prescribed by the commissioner, 980
to support amendments and shall ensure the confidentiality of such 981
documentation as required by law. The date of amendment and a 982
summary description of the evidence submitted in support of the 983
amendment shall be endorsed on or made part of the record and the 984
original certificate shall be marked "Amended", except for amendments 985
[due to] concerning parentage, [or] gender change or the legally 986
changed name of a parent. When the registrar of the town in which the 987
vital event occurred amends a certificate, such registrar shall, within ten 988
days of making such amendment, forward an amended certificate to the 989
commissioner and to any registrar having a copy of the certificate. When 990
the commissioner amends a birth certificate, including changes [due to] 991
concerning parentage, [or] gender change or the legally changed name 992
of a parent, the commissioner shall forward an amended certificate to 993
the registrars of vital statistics affected and their records shall be 994
amended accordingly. 995
(c) An amended certificate shall supersede the original certificate that 996 Substitute Bill No. 10
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has been changed and shall be marked "Amended", except for 997
amendments [due to] concerning parentage, [or] gender change or the 998
legally changed name of a parent. The original certificate in the case of 999
amendments concerning parentage, [or] gender change or the legally 1000
changed name of a parent shall be physically or electronically sealed 1001
and kept in a confidential file by the department and the registrar of any 1002
town in which the birth was recorded, and may be unsealed for issuance 1003
only as provided in section 7-53 with regard to an original birth 1004
certificate or upon a written order of a court of competent jurisdiction. 1005
The amended certificate shall become the official record. 1006
(d) (1) Upon receipt of (A) an acknowledgment of parentage executed 1007
in accordance with the provisions of sections 46b-476 to 46b-487, 1008
inclusive, by both parents of a child, or (B) a certified copy of an order 1009
of a court of competent jurisdiction establishing the parentage of a child, 1010
the commissioner shall include on or amend, as appropriate, such 1011
child's birth certificate to show such parentage if parentage is not 1012
already shown on such birth certificate and to change the name of the 1013
child under eighteen years of age if so indicated on the acknowledgment 1014
of parentage form or within the certified court order as part of the 1015
parentage action. If a person who is the subject of a voluntary 1016
acknowledgment of parentage, as described in this subdivision, is 1017
eighteen years of age or older, the commissioner shall obtain a notarized 1018
affidavit from such person affirming that such person agrees to the 1019
commissioner's amendment of such person's birth certificate as such 1020
amendment relates to the acknowledgment of parentage. The 1021
commissioner shall amend the birth certificate for an adult child to 1022
change the child's name only pursuant to a court order. 1023
(2) If the birth certificate lists the information of a parent other than 1024
the parent who gave birth, the commissioner shall not remove or replace 1025
the parent's information unless presented with a certified court order 1026
that meets the requirements specified in section 7-50, or upon the proper 1027
filing of a rescission, in accordance with the provisions of section 46b-1028
570. The commissioner shall thereafter amend such child's birth 1029 Substitute Bill No. 10
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certificate to remove or change the name of the parent other than the 1030
person who gave birth and, if relevant, to change the name of the child, 1031
as requested at the time of the filing of a rescission, in accordance with 1032
the provisions of section 46b-570. Birth certificates amended under this 1033
subsection shall not be marked "Amended". 1034
(e) When the parent or parents of a child request the amendment of 1035
the child's birth certificate to reflect a new name of the parent who gave 1036
birth because the name on the original certificate is fictitious, such 1037
parent or parents shall obtain an order of a court of competent 1038
jurisdiction declaring the person who gave birth to be the child's parent. 1039
Upon receipt of a certified copy of such order, the department shall 1040
amend the child's birth certificate to reflect the parent's true name. 1041
(f) Upon receipt of a certified copy of an order of a court of competent 1042
jurisdiction changing the name of a person born in this state and upon 1043
request of such person or such person's parents, guardian, or legal 1044
representative, the commissioner or the registrar of vital statistics of the 1045
town in which the vital event occurred shall amend the birth certificate 1046
to show the new name by a method prescribed by the department. 1047
(g) When an applicant submits the documentation required by the 1048
regulations to amend a vital record, the commissioner shall hold a 1049
hearing, in accordance with chapter 54, if the commissioner has 1050
reasonable cause to doubt the validity or adequacy of such 1051
documentation. 1052
(h) When an amendment under this section involves the changing of 1053
existing language on a death certificate due to an error pertaining to the 1054
cause of death, the death certificate shall be amended in such a manner 1055
that the original language is still visible. A copy of the death certificate 1056
shall be made. The original death certificate shall be sealed and kept in 1057
a confidential file at the department and only the commissioner may 1058
order it unsealed. The copy shall be amended in such a manner that the 1059
language to be changed is no longer visible. The copy shall be a public 1060
document. 1061 Substitute Bill No. 10
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(i) The commissioner shall issue a new birth certificate to reflect a 1062
gender change upon receipt of the following documents submitted in 1063
the form and manner prescribed by the commissioner: (1) A written 1064
request from the applicant, signed under penalty of law, for a 1065
replacement birth certificate to reflect that the applicant's gender differs 1066
from the sex designated on the original birth certificate; (2) a notarized 1067
affidavit by a physician licensed pursuant to chapter 370 or holding a 1068
current license in good standing in another state, a physician assistant 1069
licensed pursuant to chapter 370 or holding a current license in good 1070
standing in another state, an advanced practice registered nurse 1071
licensed pursuant to chapter 378 or holding a current license in good 1072
standing in another state, or a psychologist licensed pursuant to chapter 1073
383 or holding a current license in good standing in another state, stating 1074
that the applicant has undergone surgical, hormonal or other treatment 1075
clinically appropriate for the applicant for the purpose of gender 1076
transition; and (3) if an applicant is also requesting a change of name 1077
listed on the original birth certificate, proof of a legal name change. The 1078
new birth certificate shall reflect the new gender identity by way of a 1079
change in the sex designation on the original birth certificate and, if 1080
applicable, the legal name change. 1081
(j) The commissioner shall issue a new birth certificate to reflect the 1082
legally changed name of a parent of the child who is the subject of such 1083
birth certificate upon receipt of the following documents, submitted in 1084
a form and manner prescribed by the commissioner: (1) A written 1085
request from the parent, signed under penalty of law, for a replacement 1086
birth certificate to reflect that the parent's legal name differs from the 1087
name designated on the original birth certificate, and (2) proof of such 1088
parent's legal name change. 1089
[(j)] (k) The commissioner shall issue a new marriage certificate to 1090
reflect a gender change upon receipt of the following documents, 1091
submitted in a form and manner prescribed by the commissioner: (1) A 1092
written request from the applicant, signed under penalty of law, for a 1093
replacement marriage certificate to reflect that the applicant's gender 1094 Substitute Bill No. 10
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differs from the sex designated on the original marriage certificate, 1095
along with an affirmation that the marriage is still legally intact; (2) a 1096
notarized statement from the spouse named on the marriage certificate 1097
to be amended, consenting to the amendment; (3) (A) a United States 1098
passport or amended birth certificate or court order reflecting the 1099
applicant's gender as of the date of the request, or (B) a notarized 1100
affidavit by a physician licensed pursuant to chapter 370 or holding a 1101
current license in good standing in another state, physician assistant 1102
licensed pursuant to chapter 370 or holding a current license in good 1103
standing in another state, an advanced practice registered nurse 1104
licensed pursuant to chapter 378 or holding a current license in good 1105
standing in another state or a psychologist licensed pursuant to chapter 1106
383 or holding a current license in good standing in another state stating 1107
that the applicant has undergone surgical, hormonal or other treatment 1108
clinically appropriate for the applicant for the purpose of gender 1109
transition; and (4) if an applicant is also requesting a change of name 1110
listed on the original marriage certificate, proof of a legal name change. 1111
The new marriage certificate shall reflect the new gender identity by 1112
way of a change in the sex designation on the original marriage 1113
certificate and, if applicable, the legal name change. 1114
Sec. 17. (NEW) (Effective from passage) (a) For purposes of this section, 1115
"inmate" and "prisoner" have the same meanings as provided in section 1116
18-84 of the general statutes. 1117
(b) Not later than thirty days after the written request of any inmate 1118
or prisoner whose name has been ordered changed pursuant to section 1119
45a-99 or section 52-11 of the general statutes, the Commissioner of 1120
Correction shall change such inmate or prisoner's name in the records 1121
of the Department of Correction in accordance with such order. Any 1122
such written request shall be accompanied by a certified copy of such 1123
order. 1124
Sec. 18. Section 18-81ii of the general statutes is repealed and the 1125
following is substituted in lieu thereof (Effective July 1, 2023): 1126 Substitute Bill No. 10
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Any inmate of a correctional institution, as described in section 18-78, 1127
who has a gender identity that differs from the inmate's assigned sex at 1128
birth and has a diagnosis of gender dysphoria, as set forth in the most 1129
recent edition of the American Psychiatric Association's "Diagnostic and 1130
Statistical Manual of Mental Disorders" or gender incongruence, as 1131
defined in the 11
th
revision of the "International Statistical Classification 1132
of Diseases and Related Health Problems", shall: (1) Be addressed by 1133
correctional staff in a manner that is consistent with the inmate's gender 1134
identity, (2) have access to commissary items, clothing, personal 1135
property, programming and educational materials that are consistent 1136
with the inmate's gender identity, and (3) have the right to be searched 1137
by a correctional staff member of the same gender identity, unless the 1138
inmate requests otherwise or under exigent circumstances. An inmate 1139
who has a birth certificate, passport or driver's license that reflects his 1140
or her gender identity or who can meet established standards for 1141
obtaining such a document to confirm the inmate's gender identity shall 1142
presumptively be placed in a correctional institution with inmates of the 1143
gender consistent with the inmate's gender identity. Such presumptive 1144
placement may be overcome by a demonstration by the Commissioner 1145
of Correction, or the commissioner's designee, that the placement would 1146
present significant safety, management or security problems. In making 1147
determinations pursuant to this section, the inmate's views with respect 1148
to his or her safety shall be given serious consideration by the 1149
Commissioner of Correction, or the commissioner's designee. 1150
Sec. 19. Section 52-571m of the general statutes is repealed and the 1151
following is substituted in lieu thereof (Effective July 1, 2023): 1152
(a) As used in this section: 1153
(1) "Reproductive health care services" includes all medical, surgical, 1154
counseling or referral services relating to the human reproductive 1155
system, including, but not limited to, services relating to pregnancy, 1156
contraception or the termination of a pregnancy and all medical care 1157
relating to treatment of gender dysphoria as set forth in the most recent 1158
edition of the American Psychiatric Association's "Diagnostic and 1159 Substitute Bill No. 10
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Statistical Manual of Mental Disorders" and gender incongruence, as 1160
defined in the 11
th
revision of the "International Statistical Classification 1161
of Diseases and Related Health Problems"; and 1162
(2) "Person" includes an individual, a partnership, an association, a 1163
limited liability company or a corporation. 1164
(b) When any person has had a judgment entered against such 1165
person, in any state, where liability, in whole or in part, is based on the 1166
alleged provision, receipt, assistance in receipt or provision, material 1167
support for, or any theory of vicarious, joint, several or conspiracy 1168
liability derived therefrom, for reproductive health care services that are 1169
permitted under the laws of this state, such person may recover 1170
damages from any party that brought the action leading to that 1171
judgment or has sought to enforce that judgment. Recoverable damages 1172
shall include: (1) Just damages created by the action that led to that 1173
judgment, including, but not limited to, money damages in the amount 1174
of the judgment in that other state and costs, expenses and reasonable 1175
attorney's fees spent in defending the action that resulted in the entry of 1176
a judgment in another state; and (2) costs, expenses and reasonable 1177
attorney's fees incurred in bringing an action under this section as may 1178
be allowed by the court. 1179
(c) The provisions of this section shall not apply to a judgment 1180
entered in another state that is based on: (1) An action founded in tort, 1181
contract or statute, and for which a similar claim would exist under the 1182
laws of this state, brought by the patient who received the reproductive 1183
health care services upon which the original lawsuit was based or the 1184
patient's authorized legal representative, for damages suffered by the 1185
patient or damages derived from an individual's loss of consortium of 1186
the patient; (2) an action founded in contract, and for which a similar 1187
claim would exist under the laws of this state, brought or sought to be 1188
enforced by a party with a contractual relationship with the person that 1189
is the subject of the judgment entered in another state; or (3) an action 1190
where no part of the acts that formed the basis for liability occurred in 1191
this state. 1192 Substitute Bill No. 10
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Sec. 20. Section 52-571n of the general statutes is repealed and the 1193
following is substituted in lieu thereof (Effective July 1, 2023): 1194
(a) As used in this section: 1195
(1) "Gender-affirming health care services" means all medical care 1196
relating to the treatment of gender dysphoria as set forth in the most 1197
recent edition of the American Psychiatric Association's "Diagnostic and 1198
Statistical Manual of Mental Disorders" and gender incongruence, as 1199
defined in the 11
th
revision of the "International Statistical Classification 1200
of Diseases and Related Health Problems"; 1201
(2) "Reproductive health care services" includes all medical, surgical, 1202
counseling or referral services relating to the human reproductive 1203
system, including, but not limited to, services relating to pregnancy, 1204
contraception or the termination of a pregnancy; and 1205
(3) "Person" includes an individual, a partnership, an association, a 1206
limited liability company or a corporation. 1207
(b) When any person has had a judgment entered against such 1208
person, in any state, where liability, in whole or in part, is based on the 1209
alleged provision, receipt, assistance in receipt or provision, material 1210
support for, or any theory of vicarious, joint, several or conspiracy 1211
liability derived therefrom, for reproductive health care services and 1212
gender-affirming health care services that are permitted under the laws 1213
of this state, such person may recover damages from any party that 1214
brought the action leading to that judgment or has sought to enforce that 1215
judgment. Recoverable damages shall include: (1) Just damages created 1216
by the action that led to that judgment, including, but not limited to, 1217
money damages in the amount of the judgment in that other state and 1218
costs, expenses and reasonable attorney's fees spent in defending the 1219
action that resulted in the entry of a judgment in another state; and (2) 1220
costs, expenses and reasonable attorney's fees incurred in bringing an 1221
action under this section as may be allowed by the court. 1222
(c) The provisions of this section shall not apply to a judgment 1223 Substitute Bill No. 10
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entered in another state that is based on: (1) An action founded in tort, 1224
contract or statute, and for which a similar claim would exist under the 1225
laws of this state, brought by the patient who received the reproductive 1226
health care services or gender-affirming health care services upon which 1227
the original lawsuit was based or the patient's authorized legal 1228
representative, for damages suffered by the patient or damages derived 1229
from an individual's loss of consortium of the patient; (2) an action 1230
founded in contract, and for which a similar claim would exist under 1231
the laws of this state, brought or sought to be enforced by a party with 1232
a contractual relationship with the person that is the subject of the 1233
judgment entered in another state; or (3) an action where no part of the 1234
acts that formed the basis for liability occurred in this state. 1235
Sec. 21. Subsection (b) of section 45a-106a of the general statutes, as 1236
amended by section 52 of public act 22-26, is repealed and the following 1237
is substituted in lieu thereof (Effective July 1, 2023): 1238
(b) The fee to file each of the following motions, petitions or 1239
applications in a Probate Court is two hundred fifty dollars: 1240
(1) With respect to a minor child: (A) Appoint a temporary guardian, 1241
temporary custodian, guardian, coguardian, permanent guardian or 1242
statutory parent, (B) remove a guardian, including the appointment of 1243
another guardian, (C) reinstate a parent as guardian, (D) terminate 1244
parental rights, including the appointment of a guardian or statutory 1245
parent, (E) grant visitation, (F) make findings regarding special 1246
immigrant juvenile status, (G) approve placement of a child for 1247
adoption outside this state, (H) approve an adoption, (I) validate a 1248
foreign adoption, (J) review, modify or enforce a cooperative 1249
postadoption agreement, (K) review an order concerning contact 1250
between an adopted child and his or her siblings, (L) resolve a dispute 1251
concerning a standby guardian, (M) approve a plan for voluntary 1252
services provided by the Department of Children and Families, (N) 1253
determine whether the termination of voluntary services provided by 1254
the Department of Children and Families is in accordance with 1255
applicable regulations, (O) conduct an in-court review to modify an 1256 Substitute Bill No. 10
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order, (P) grant emancipation, (Q) grant approval to marry, (R) transfer 1257
funds to a custodian under sections 45a-557 to 45a-560b, inclusive, (S) 1258
appoint a successor custodian under section 45a-559c, (T) resolve a 1259
dispute concerning custodianship under sections 45a-557 to 45a-560b, 1260
inclusive, and (U) grant authority to purchase real estate; 1261
(2) Determine parentage; 1262
(3) Validate a genetic surrogacy agreement; 1263
(4) Determine the age and date of birth of an adopted person born 1264
outside the United States; 1265
(5) With respect to adoption records: (A) Appoint a guardian ad litem 1266
for a biological relative who cannot be located or appears to be 1267
incompetent, (B) appeal the refusal of an agency to release information, 1268
(C) release medical information when required for treatment, and (D) 1269
grant access to an original birth certificate; 1270
(6) Approve an adult adoption; 1271
(7) With respect to a conservatorship: (A) Appoint a temporary 1272
conservator, conservator or special limited conservator, (B) change 1273
residence, terminate a tenancy or lease, sell or dispose household 1274
furnishings, or place in a long-term care facility, (C) determine 1275
competency to vote, (D) approve a support allowance for a spouse, (E) 1276
grant authority to elect the spousal share, (F) grant authority to purchase 1277
real estate, (G) give instructions regarding administration of a joint asset 1278
or liability, (H) distribute gifts, (I) grant authority to consent to 1279
involuntary medication, (J) determine whether informed consent has 1280
been given for voluntary admission to a hospital for psychiatric 1281
disabilities, (K) determine life-sustaining medical treatment, (L) transfer 1282
to or from another state, (M) modify the conservatorship in connection 1283
with a periodic review, (N) excuse accounts under rules of procedure 1284
approved by the Supreme Court under section 45a-78, (O) terminate the 1285
conservatorship, and (P) grant a writ of habeas corpus; 1286 Substitute Bill No. 10
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(8) With respect to a power of attorney: (A) Compel an account by an 1287
agent, (B) review the conduct of an agent, (C) construe the power of 1288
attorney, and (D) mandate acceptance of the power of attorney; 1289
(9) Resolve a dispute concerning advance directives or life-sustaining 1290
medical treatment when the individual does not have a conservator or 1291
guardian; 1292
(10) With respect to an elderly person, as defined in section 17b-450: 1293
(A) Enjoin an individual from interfering with the provision of 1294
protective services to such elderly person, and (B) authorize the 1295
Commissioner of Social Services to enter the premises of such elderly 1296
person to determine whether such elderly person needs protective 1297
services; 1298
(11) With respect to an adult with intellectual disability: (A) Appoint 1299
a temporary limited guardian, guardian or standby guardian, (B) grant 1300
visitation, (C) determine competency to vote, (D) modify the 1301
guardianship in connection with a periodic review, (E) determine life-1302
sustaining medical treatment, (F) approve an involuntary placement, 1303
(G) review an involuntary placement, (H) authorize a guardian to 1304
manage the finances of such adult, and (I) grant a writ of habeas corpus; 1305
(12) With respect to psychiatric disability: (A) Commit an individual 1306
for treatment, (B) issue a warrant for examination of an individual at a 1307
general hospital, (C) determine whether there is probable cause to 1308
continue an involuntary confinement, (D) review an involuntary 1309
confinement for possible release, (E) authorize shock therapy, (F) 1310
authorize medication for treatment of psychiatric disability, (G) review 1311
the status of an individual under the age of sixteen as a voluntary 1312
patient, and (H) recommit an individual under the age of sixteen for 1313
further treatment; 1314
(13) With respect to drug or alcohol dependency: (A) Commit an 1315
individual for treatment, (B) recommit an individual for further 1316
treatment, and (C) terminate an involuntary confinement; 1317 Substitute Bill No. 10
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(14) With respect to tuberculosis: (A) Commit an individual for 1318
treatment, (B) issue a warrant to enforce an examination order, and (C) 1319
terminate an involuntary confinement; 1320
(15) Compel an account by the trustee of an inter vivos trust, 1321
custodian under sections 45a-557 to 45a-560b, inclusive, or treasurer of 1322
an ecclesiastical society or cemetery association; 1323
(16) With respect to a testamentary or inter vivos trust: (A) Construe, 1324
validate, divide, combine, reform, modify or terminate the trust, (B) 1325
enforce the provisions of a pet trust, (C) excuse a final account under 1326
rules of procedure approved by the Supreme Court under section 45a-1327
78, and (D) assume jurisdiction of an out-of-state trust; 1328
(17) Authorize a fiduciary to establish a trust; 1329
(18) Appoint a trustee for a missing person; 1330
[(19) Change a person's name;] 1331
[(20)] (19) Issue an order to amend the birth certificate of an 1332
individual born in another state to reflect a gender change; 1333
[(21)] (20) Require the Department of Public Health to issue a delayed 1334
birth certificate; 1335
[(22)] (21) Compel the board of a cemetery association to disclose the 1336
minutes of the annual meeting; 1337
[(23)] (22) Issue an order to protect a grave marker; 1338
[(24)] (23) Restore rights to purchase, possess and transport firearms; 1339
[(25)] (24) Issue an order permitting sterilization of an individual; 1340
[(26)] (25) Approve the transfer of structured settlement payment 1341
rights; and 1342
[(27)] (26) With respect to any case in a Probate Court other than a 1343 Substitute Bill No. 10
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decedent's estate: (A) Compel or approve an action by the fiduciary, (B) 1344
give instruction to the fiduciary, (C) authorize a fiduciary to 1345
compromise a claim, (D) list, sell or mortgage real property, (E) 1346
determine title to property, (F) resolve a dispute between cofiduciaries 1347
or among fiduciaries, (G) remove a fiduciary, (H) appoint a successor 1348
fiduciary or fill a vacancy in the office of fiduciary, (I) approve fiduciary 1349
or attorney's fees, (J) apply the doctrine of cy pres or approximation, (K) 1350
reconsider, modify or revoke an order, and (L) decide an action on a 1351
probate bond. 1352
Sec. 22. (Effective from passage) (a) As used in this section, "gender-1353
affirming procedure" means a medical procedure or treatment to alter 1354
the physical characteristics of a person diagnosed with (1) gender 1355
dysphoria, as described in the most recent edition of the American 1356
Psychiatric Association's "Diagnostic and Statistical Manual of Mental 1357
Disorders", or (2) gender incongruence, as defined in the 11
th
revision of 1358
the "International Statistical Classification of Diseases and Related 1359
Health Problems", in a manner consistent with such person's gender 1360
identity. 1361
(b) The Commissioner of Social Services shall establish a working 1362
group to seek input on amendments to the department's gender-1363
affirming procedures guidelines not later than one hundred twenty 1364
days before amending such guidelines. The working group shall consist 1365
of (1) six health care providers who treat persons seeking gender-1366
affirming procedures or persons who have had such procedures, (2) two 1367
HUSKY Health program members who have had such procedures, and 1368
(3) the commissioner or the commissioner's designee. All appointments 1369
to the working group shall be made by the commissioner. The 1370
commissioner, or the commissioner's designee, shall serve as 1371
cochairperson of the working group with a member chosen by the 1372
majority of working group members to serve as cochairperson. 1373
(c) The commissioner, or the commissioner's designee, shall convene 1374
the working group not later than ninety days before any amendments 1375
planned for the gender-affirming procedures guidelines. The group 1376 Substitute Bill No. 10
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shall meet not less than two times monthly. 1377
(d) The commissioner shall file a report, in accordance with the 1378
provisions of section 11-4a of the general statutes, to the joint standing 1379
committees of the General Assembly having cognizance of matters 1380
relating to human services and public health not later than thirty days 1381
before any amendments the commissioner has proposed for the gender-1382
affirming procedure guidelines. The report shall include, but not be 1383
limited to, (1) the proposed amendments, and (2) the working group's 1384
recommendations concerning such amendments. The working group 1385
shall terminate on the date such report is issued. 1386
(e) The provisions of this section shall not apply to any changes 1387
required to be made to the gender-affirming procedure guidelines to 1388
comply with federal law or regulations concerning reimbursement for 1389
such procedures under Title XIX or Title XXI of the Social Security Act. 1390
This act shall take effect as follows and shall amend the following
sections:
Section 1 July 1, 2023 19a-754b(d)
Sec. 2 January 1, 2024, and
applicable to contracts
entered into, amended or
renewed on and after
January 1, 2024
New section
Sec. 3 January 1, 2024, and
applicable to contracts
entered into, amended or
renewed on and after
January 1, 2024
New section
Sec. 4 January 1, 2024, and
applicable to contracts
entered into, amended or
renewed on and after
January 1, 2024
New section
Sec. 5 July 1, 2023 New section
Sec. 6 July 1, 2023 New section
Sec. 7 July 1, 2023 New section Substitute Bill No. 10
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Sec. 8 July 1, 2023 3-112
Sec. 9 January 1, 2024 38a-477g
Sec. 10 July 1, 2023 17b-242(a)
Sec. 11 from passage New section
Sec. 12 from passage 19a-754a(b)
Sec. 13 from passage 17b-312
Sec. 14 from passage New section
Sec. 15 from passage 38a-1084
Sec. 16 July 1, 2023 19a-42
Sec. 17 from passage New section
Sec. 18 July 1, 2023 18-81ii
Sec. 19 July 1, 2023 52-571m
Sec. 20 July 1, 2023 52-571n
Sec. 21 July 1, 2023 45a-106a(b)
Sec. 22 from passage New section
Statement of Legislative Commissioners:
In Section 1(d)(3), "wholesale acquisition cost of the drug" was changed
to "wholesale acquisition cost of the drug, less all rebates paid to the
state for such drug during the immediately preceding calendar year,"
for consistency; Section 6 was redrafted for clarity; in Section 7(c), "thirty
days after the effective date of this section" was changed to "August 1,
2023" for clarity; in Section 7(d), "sixty days after the effective date of
this section" was changed to "September 1, 2023" for clarity; in Section
9(b)(1), "[2017] 2024" was changed to "2017" for clarity; in Sections 9(f)
and 9(g) "On and after January, 1 2024," was added for clarity; in Section
16(c), "in the case of parentage" was changed to "in the case of
amendments concerning parentage" for accuracy; in Sections 18 to 20,
inclusive, "11
th
edition of the "International Statistical Classification of
Diseases and Related Health Problems"" was changed to "11
th
revision
of the "International Statistical Classification of Diseases and Related
Health Problems"" for accuracy; and in Section 22, "(NEW)" was
removed for accuracy, "11
th
edition of the "International Statistical
Classification of Diseases and Related Health Problems"" was changed
to "11
th
revision of the "International Statistical Classification of Diseases
and Related Health Problems"" for accuracy, and the first sentence of
Section 22(b) was redrafted for clarity.
HS Joint Favorable C/R APP Substitute Bill No. 10
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APP Joint Favorable Subst.-LCO